Original article
Bowel Frequency and Defecatory Patterns in Children: A Prospective Nationwide Survey

https://doi.org/10.1016/S1542-3565(05)00848-7Get rights and content

Background & Aims: Very little is known about several aspects of bowel habits in the general pediatric population and the aim of this nationwide survey was to assess bowel frequency and modalities of defecation in children. Methods: The survey was conducted by 58 pediatricians who were selected randomly and distributed evenly throughout Italy. The following items were reported by each pediatrician in a standardized questionnaire: sociodemographic data, frequency and modalities of bowel evacuation, and anorectal disorders. Results: The response rate of available completed questionnaires was distributed evenly for the 1-year age group and was 94% (number of patients, 2680; 1–2 years, 442; females, 49.8%). Mean bowel frequency did not vary in the first 2 years of life, it decreased (P = .00001) after the second year, and remained stable until the 12th year; it did not differ between sexes. Mean bowel frequency was reduced significantly in children, both in those younger or older than 2 years, with a positive history of constipation in the parents (P = .00002). Bowel frequency was inversely correlated with the number of persons living and the number of rooms in the child’s house (P < .05, P = .008, respectively). Stool consistency, duration of evacuation, and frequency of episodes of painful defecation showed an inverse relationship (P < .001) with bowel frequency. Bowel frequency was significantly lower (P < .001) in children with anorectal disorders. Conclusions: In Italian children, bowel frequency does not differ between sexes but it differed between the first 2 years of life and age older than 2. Anorectal disorders increase as bowel frequency decreases.

Section snippets

Patients and Methods

All children from birth to 12 years of age are enrolled in the National Health Service (NHS) in Italy. Care of children is assigned to each of the NHS pediatricians in groups of approximately 800, which are distributed evenly over the country to cover the needs of the entire Italian pediatric population.

Initially, an equal number of pediatricians belonging to centronorthern and southern Italy were selected randomly from the regional NHS list. Subsequently, regional coordinators of the study

Demographic and Socioeconomic Features

There were 2680 (94%) satisfactorily completed and returned questionnaires. There were 2065 (77%) obtained from routine follow-up visits and 615 (23%) obtained from children affected by acute intercurrent illness not affecting the gastrointestinal tract. Questionnaires referred to comparable numbers of female (49.8%) and male (50.2%) children distributed evenly for the 1-year age group and for the 2 main Italian geographic areas. Table 2, Table 3 summarize the demographic, socioeconomic, and

Discussion

This nationwide study was made possible because of the structure of the Italian NHS, in which all citizens aged 0–12 years are subdivided evenly and assigned to pediatricians who are distributed evenly throughout the country.

The proper selection of a representative nationwide sample of the entire pediatric population was possible by randomly selecting pediatricians from the NHS regional lists who geographically were distributed evenly. These selected pediatricians obtained the relevant data for

Acknowledgment

The authors would like to thank the following pediatricians who made this study possible: Coordinators: M. R. Andreotti, G. Boschi, F. Cataldo, M. Fontana, S. Guandalini, G. Oderda, A. Ponticelli, M. Sanfilippo, L. Tarallo; NHS pediatricians: L. Alessandrini, A. Aloisio, L. Amato, M. R. Andreotti, S. Appendino, G. Ariatti, P. Azzoli, G. Bartoli, S. Bondavalli, A. Bozzanello, M. Caloiero, S. Capobianco, M. Caracalla, M. Caramello, L. Carbognani, A. Centineo, M. D. Chelucci, M. Comparetto, M.

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